TY - JOUR
T1 - The extent of microbiological testing is associated with alteration of antibiotic therapy in adults with community-acquired pneumonia
AU - Wittermans, Esther
AU - Vestjens, Stefan M.T.
AU - Bos, Willem Jan W.
AU - Grutters, Jan C.
AU - van de Garde, Ewoudt M.W.
AU - Vlaminckx, Bart J.M.
N1 - Funding Information:
Funding This work was supported by a grant from the St. Antonius Research Fund via an earmarked donation from Verwelius Construction Corporation for research on CAP.
Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - The aim of this study was to explore the relationship between the extent of microbiological testing and the frequency of antibiotic alteration in adults hospitalised with community-acquired pneumonia (CAP). We retrospectively studied 283 immunocompetent patients hospitalised with CAP. Information on microbiological testing and prescribed antibiotics was obtained. Patients were grouped according to the number of different microbiological tests performed within the first 2 days of admission (0–5 tests). Alteration rates were compared between these groups. Antimicrobial alteration was defined as a switch at day 3 of hospital stay to (1) a narrower spectrum antibiotics, or (2) a different class of antibiotics, or (3) a switch from dual therapy to monotherapy (4) or discontinuation of antibiotic treatment because the indication for antibiotic treatment did no longer exist. For each additional test performed, a stepwise increase in percentage of patients with altered antibiotic regimen ranging from 0 to 59% (p = 0.001) was found. Multivariate logistic regression analyses showed that performing PCR assay for atypical pathogens was most strongly associated with any alteration of antibiotic treatment (OR 2.6 (95% CI 1.4–4.9)) and with changes in atypical coverage specifically (OR 3.1 (95% CI 1.6–6.0). The extent of microbiological testing was positively associated with antibiotic alteration in adults hospitalised with CAP. Antibiotic treatment was most likely to be altered in patients in whom PCR assay for atypical pathogens was performed.
AB - The aim of this study was to explore the relationship between the extent of microbiological testing and the frequency of antibiotic alteration in adults hospitalised with community-acquired pneumonia (CAP). We retrospectively studied 283 immunocompetent patients hospitalised with CAP. Information on microbiological testing and prescribed antibiotics was obtained. Patients were grouped according to the number of different microbiological tests performed within the first 2 days of admission (0–5 tests). Alteration rates were compared between these groups. Antimicrobial alteration was defined as a switch at day 3 of hospital stay to (1) a narrower spectrum antibiotics, or (2) a different class of antibiotics, or (3) a switch from dual therapy to monotherapy (4) or discontinuation of antibiotic treatment because the indication for antibiotic treatment did no longer exist. For each additional test performed, a stepwise increase in percentage of patients with altered antibiotic regimen ranging from 0 to 59% (p = 0.001) was found. Multivariate logistic regression analyses showed that performing PCR assay for atypical pathogens was most strongly associated with any alteration of antibiotic treatment (OR 2.6 (95% CI 1.4–4.9)) and with changes in atypical coverage specifically (OR 3.1 (95% CI 1.6–6.0). The extent of microbiological testing was positively associated with antibiotic alteration in adults hospitalised with CAP. Antibiotic treatment was most likely to be altered in patients in whom PCR assay for atypical pathogens was performed.
KW - Antimicrobial stewardship
KW - Bacterial pneumonia
KW - Polymerase chain reaction
UR - http://www.scopus.com/inward/record.url?scp=85065123910&partnerID=8YFLogxK
U2 - 10.1007/s10096-019-03561-8
DO - 10.1007/s10096-019-03561-8
M3 - Article
C2 - 31025133
AN - SCOPUS:85065123910
SN - 0934-9723
VL - 38
SP - 1359
EP - 1366
JO - European Journal of Clinical Microbiology and Infectious Diseases
JF - European Journal of Clinical Microbiology and Infectious Diseases
IS - 7
ER -